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目的 探讨子宫托治疗女性盆腔器官脱垂(POP)的临床并发症特征，并分析影响患者治疗依从性的因素与子宫托治疗的管理，以期为个体化临床路径提供循证依据。方法 采用回顾性病例研究，分析2020年1月—2024年12月在吉林省人民医院妇科应用子宫托治疗的297例POP患者的临床资料(其中Gellhorn型子宫托86例，环形子宫托211例)。依据Clavien-Dindo并发症分级系统评估损伤程度，分析并发症发生原因及其影响因素。结果 总体并发症发生率为87.2%(259/297),阴道分泌物增多是置入后最普遍的并发症(发生率64.0%),Gellhorn组与环形组在无症状比例(5.8%vs.15.6%,χ2=5.287,P<0.05)及阴道分泌物增多发生率比较差异有统计学意义(75.6%vs.59.2%,χ2=7.078,P<0.05),Gellhorn组引起阴道出血及擦伤的风险显著高于环形组(7.0%vs.1.9%,P<0.05),其相对风险度为后者的3.7倍。Gellhorn组与环形组在单纯异物感、隐匿性压力性尿失禁、子宫托脱落、排尿困难及排便困难等并发症方面比较差异均无统计学意义(均P>0.05)。临床需高度警惕“被遗忘综合征”,嵌顿、瘘管等严重(GradeⅢ～Ⅴ)并发症直接与随访中断或长期忽视护理相关联。结论 中国成年女性症状性POP患病率为9.6%,而且随着老龄化趋势显著升高。子宫托是治疗POP的安全基石，但其并发症影响治疗效果、降低患者的依从性，从而限制其临床应用范围，建立科学合理的并发症监测与评估体系，尽可能地控制并发症，提高子宫托疗效。未来结合3D打印技术的个体化定制有望从几何力学层面彻底解决传统器械对萎缩黏膜的压力损伤，实现治疗效能与患者依从性的双重跨越。
Abstract：Objective To delineate the clinico-pathological spectrum of complications associated with pessary therapy for female pelvic organ prolapse(POP), elucidate the determinants of therapeutic compliance, and appraise management paradigms, thereby furnishing an evidence-based scaffold for individualized clinical pathways.Methods A retrospective case-series analysis was conducted encompassing 297 POP patients managed with vaginal pessaries at Jilin Provincial People's Hospital between 2020 and 2024(Gellhorn type, n=86; ring type, n=211).Complication severity was stratified utilizing the Clavien-Dindo grading system, with etiological dissection and multivariate analysis of contributing factors.Results In the present cohort, the overall complication rate was 87.2%(259/297).Increased vaginal discharge emerged as the most prevalent sequela following pessary insertion(64.0%).Intergroup comparisons revealed statistically significant differences between the Gellhorn and ring cohorts in the proportion of asymptomatic patients(5.8% vs.15.6%; χ2=5.287, P<0.05) and the incidence of increased vaginal discharge(75.6% vs.59.2%; χ2=7.078, P<0.05).The Gellhorn cohort demonstrated a significantly elevated risk of vaginal bleeding, abrasion, and ulceration relative to the ring cohort(7.0% vs.1.9%; P<0.05), with a corresponding relative risk of 3.7.No statistically significant intergroup differences were observed for isolated foreign body sensation, occult stress urinary incontinence, pessary expulsion, voiding dysfunction, or defecatory dysfunction between Gellhorm group and ring group(all P>0.05).Clinicians must maintain heightened vigilance for the "forgotten pessary syndrome". Severe complications(Clavien-Dindo Grades Ⅲ-Ⅴ), including pessary incarceration and fistula formation, are directly attributable to discontinuation of follow-up or prolonged neglect of pessary care.Conclusion The prevalence of symptomatic POP among adult women in China is 9.6%, with a marked upward trajectory driven by population aging.Pessary therapy constitutes a safe and foundational conservative approach; however, its associated complications compromise treatment efficacy, erode patient compliance, and thereby constrain its broader clinical adoption.The establishment of a rigorous, standardized complication surveillance and risk-stratification framework-coupled with systematic complication mitigation-will be essential to optimizing pessary outcomes.Looking ahead, individualized pessary fabrication leveraging three-dimensional printing technology holds promise for resolving the geometric and biomechanical pressure-induced mucosal injury inherent to conventional devices, potentially achieving a paradigm shift in both therapeutic efficacy and long-term patient compliance.
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基本信息:
DOI：10.19829/j.zgfybj.issn.1001-4411.2026.15.006
中图分类号:R711.2
引用信息:
[1]刘凤,吕小娟,唐佳松.子宫托治疗盆腔器官脱垂相关并发症的临床分析[J].中国妇幼保健,2026,41(15):2612-2615.DOI:10.19829/j.zgfybj.issn.1001-4411.2026.15.006.
基金信息:
吉林省科技发展计划项目(20240304078SF)
2026-07-24
2026-07-24